Understanding Fentanyl Abuse and Addiction
What Is Fentanyl?
Fentanyl is a powerful synthetic opioid that is similar to morphine but 50 to 100 times more potent. Even though fentanyl is a prescription medicine, the substance can also be made and used illegally. When prescribed by doctors, fentanyl is known under the following brand names:
- Actiq is a lozenge on a plastic stick that’s administered under the tongue like a lollipop. Actiq is commonly used for patients already taking pain-relieving medications in need of extra pain relief.
- Duragesic is a patch used to treat moderate to severe pain for up to 3 days.
- Sublimaze is an injectable form of fentanyl used to manage pain before and after surgeries.
- Subsys is a spray that doctors administer under a patient’s tongue. This form of fentanyl can provide immediate pain relief for cancer patients.
- Abstral is a quick-dissolving tablet that doctors place under the tongue to provide immediate relief of cancer pain.
- Lazanda is a nasal spray administered in the same way as a nasal decongestant spray.
Typically, doctors use fentanyl to treat patients with severe pain, especially after surgery. Sometimes, doctors prescribe fentanyl to patients who have chronic pain but have developed a tolerance to other pain-relieving medications. All forms of fentanyl are highly potent, addictive, and can cause overdose if they’re misused or taken more frequently or in larger doses than prescribed.
When used illegally, fentanyl may be referred to as “Apache,” “Dance Fever,” “Sublime,” “China White,” “Friend,” “Goodfellas,” “Jackpot,” “Murder 8,” or “Tango & Cash.” Both prescription and illicit fentanyl work by blocking pain receptors in the brain and increasing the production of dopamine, a chemical messenger that makes individuals feel good.
Even though fentanyl is at the center of the nation’s current opioid epidemic, the drug isn’t new.
The History of Fentanyl
Fentanyl was first developed in 1959 by a Belgian chemist. During that time, the drug was primarily used as an anesthetic and pain reliever. Around 100 times more powerful than morphine, fentanyl became the most potent opioid in the world.
In 1963, fentanyl was introduced to Western European countries, combined with other medications, and used as an intravenous painkiller. 5 years later, in 1968, the United States Food and Drug Administration (FDA) approved fentanyl for medical use. Yet the FDA’s approval had limits. Doctors could only use fentanyl in combination with droperidol to help minimize the drug’s potential for abuse. In 1972, the FDA gave doctors approval to use fentanyl on its own for severe, chronic pain.
By the late 1970s and the early 1980s, fentanyl was widely used before and after cardiac and vascular surgery. Sadly, as fentanyl’s popularity increased, misuse and overdose also increased. In the late 1980s, the FDA approved a fentanyl patch called Duragesic for patients dealing with chronic pain who had become tolerant to other opioid pain relievers. In 1998, Actiq, a lollipop-like fentanyl product, was approved to help cancer patients deal with chronic pain. Today, some fentanyl products have earned a place on the World Health Organization’s List of Essential Medicines. Despite its effectiveness, fentanyl has become one of the world’s most dangerous drugs. Because of this, many people misunderstand the substance.
Common Myths and Misconceptions About Fentanyl
Fentanyl can be a tricky substance to understand. On the one hand, the drug provides extraordinary relief to individuals suffering from severe, chronic pain. On the other hand, fentanyl is responsible for a significant amount of overdoses and deaths occurring during the opioid epidemic. Fortunately, addressing some of the misconceptions about fentanyl can help individuals better understand the substance and its risks, which can hopefully help save lives. Here are some of the most common fentanyl misconceptions and the truth behind them.
Myth #1: Because fentanyl is legal, it’s not harmful, deadly, or addictive.
Truth: Even though fentanyl is legal, the substance has a high potential for abuse. This means that fentanyl can be harmful, addictive, and deadly, especially when misused and abused. Additionally, research shows that fentanyl has caused a growing number of drug-related overdoses. In fact, the National Institute on Drug Abuse recognizes fentanyl as the most common drug involved in overdose deaths in the United States.
Fentanyl, though legal, can also lead to overdose. Because fentanyl impacts brain areas that regulate respiration and breathing, many people taking the substance experience slow, shallow breathing. This prevents the brain from getting enough oxygen, which can lead to a condition called hypoxia. Individuals with hypoxia can slip into a coma or experience permanent brain damage. If hypoxia isn’t quickly corrected, the condition can also be fatal.
Myth #2: Fentanyl sold on the streets is medical-grade and safely made in laboratories.
Truth: Many doctors believe that fentanyl is one of the main drugs responsible for the “third wave” of the opioid epidemic. Medical and emergency responders have also seen a sharp increase in the number of people overdosing on fentanyl. One reason for the increase in fentanyl-related overdoses and deaths is that drug dealers in other countries started illegally manufacturing the drug. The type of fentanyl they make isn’t regulated by any government agency. Often, these drug dealers mix fentanyl with other drugs such as heroin, increasing the potency of the substance. Currently, about 80 percent of the United States’ illegal fentanyl comes from China, but China hasn’t declared fentanyl a controlled substance. This means that drug traffickers can manufacture and manipulate the chemical any way they want. Even though some fentanyl sold on the streets is medical-grade, much is not.
Myth #3: Touching even a small amount of fentanyl can cause opioid overdose, coma, or death.
Truth: Incidental skin exposure to fentanyl is extremely unlikely to cause immediate harm. But that doesn’t mean the drug isn’t harmful. In fact, 3 milligrams of fentanyl, which is equivalent to just 3 grains of salt, can be fatal when intentionally consumed. Individuals who have accidentally handled fentanyl should immediately wash the affected area with soap and water to remove fentanyl residue. Do not use alcohol-based hand sanitizers or wipes to remove fentanyl. These products can increase the absorption of fentanyl in the skin.
Common Questions About Fentanyl
Despite the drug’s popularity, many people may be unfamiliar with what fentanyl looks like, how the drug affects the body, and the risks associated with its use. Here are some of the most common questions we hear about fentanyl.
Question #1: What does fentanyl look like?
Truth: Fentanyl can come in a variety of forms. Police have found illegal fentanyl in the following forms:
- Pills sold as fake oxycodone, ketamine, ecstasy, or gamma-hydroxybutyrate
- Powder sold as heroin or fentanyl
- Powder mixed into other drugs such as cocaine, crystal meth, or marijuana
- Patches used for purposes other than they were prescribed
Question #2: How is fentanyl different from oxycodone or other opioids?
Truth: Fentanyl is much stronger than oxycodone and other opioids. When consumed by mouth or by intravenous (IV) injection, fentanyl also has a stronger effect than most opioids.
Question #3: Can fentanyl be poisonous?
Truth: Yes, taking too much fentanyl can poison the body. Early signs of fentanyl poisoning include:
- Cold, clammy skin
- Trouble breathing which can sound like snoring
- Slow, shallow breathing
- Unresponsiveness to pain or a person’s voice
One of the most dangerous side effects of fentanyl is that it can cause individuals to stop breathing, which can lead to death.
Question #4: What should individuals do if they suspect someone is suffering from fentanyl poisoning?
Truth: Call 911 as soon as possible if the individual becomes unconscious, stops breathing, has chest pain, or has a seizure. Remove any remaining pills from the person’s mouth or patches from their skin so they don’t absorb any more fentanyl. If the individual has stopped breathing or doesn’t have a pulse, perform CPR. If you have naloxone, give it to the individual as soon as possible.
Question #5: Can prescription fentanyl be addictive?
Truth: Generally, individuals who follow their prescription correctly avoid fentanyl addiction. However, the potential for abuse remains. The DEA lists fentanyl as a Schedule II narcotic controlled substance. This means that fentanyl, despite its medical use, has a high potential for abuse. Individuals can even become mentally, physically, or psychologically dependent on fentanyl. When this happens, individuals feel like they need fentanyl to act and function normally. If they try to quit taking fentanyl, they may experience withdrawal symptoms such as:
- Stomach cramps
- Chills or goosebumps
- Fatigue and weakness
- Muscle spasms or bone pain
Individuals who think they may be developing a dependence on fentanyl should let their healthcare provider know immediately.
Question #6: If I have naloxone available, is fentanyl safe to use?
Truth: Fentanyl is safe when prescribed by a doctor and taken as directed. Fentanyl patches and lozenges release the medicine slowly. However, individuals can unintentionally poison themselves if they veer away from the prescribed dosage to get a stronger or faster effect. Naloxone can reverse symptoms of fentanyl poisoning, but naloxone doesn’t work every time and the effects of naloxone may not last as long as fentanyl’s effects.
Question #7: What are the risks of misusing fentanyl?
Truth: Taking fentanyl that has been made or sold illegally can be very risky. For example, there could be other toxic chemicals combined with fentanyl. This could increase the toxicity of the drug, making individuals more likely to overdose. Sucking on patches or cutting the patch to remove the drug can cause an accidental overdose that could be fatal.
The Dangers of Fentanyl
Many people experience the dangers of fentanyl because they have no idea how potent the substance can be.
Doctors and chemists determine the potency of opioids by comparing them to morphine. Methadone, for example, is 3 times stronger than morphine. Heroin is approximately 5 times stronger than morphine. Fentanyl is 100 times stronger than morphine and 50 times more potent than heroin. Because of this, even a small amount of fentanyl can cause an overdose. According to the Drug Enforcement Agency (DEA), 2 milligrams of fentanyl can be lethal.
All opioids can cause a fatal overdose. But because fentanyl is a powerful depressant, the drug rapidly slows activity in the central nervous system. When this happens, blood pressure slows, breathing becomes labored, and individuals’ heart rates decline. Consuming large amounts of fentanyl can cause severe respiratory suppression that causes individuals to stop breathing altogether, which can be fatal.
The number of overdose deaths caused by synthetic opioids such as fentanyl was 12 times higher in 2019 than in 2013. In fact, more than 36,000 people died from overdoses involving synthetic opioids in 2019. Sadly, many people die from misusing fentanyl because they don’t recognize the signs of a fentanyl overdose.
Some of the most common signs of a fentanyl overdose include:
- Extreme drowsiness
- Loss of consciousness
- Difficulty swallowing
- Difficulty breathing, or slow, shallow breaths
Overdosing on fentanyl is a medical emergency that can lead to death if not treated immediately. Anyone suspecting a fentanyl overdose should call for emergency help. First responders carrying naloxone can help reverse the overdose.
Remember: we’re not medical professionals. If you suspect you or a loved one may be suffering a fentanyl overdose, call 911 immediately.
Other dangers of fentanyl include:
- Life-threatening symptoms and adverse effects when mixed with certain medicines. When individuals mix fentanyl with antibiotics, antifungals, muscle relaxants, alcohol, antidepressants, sleeping pills, anti-anxiety medicine, antihistamines, or tranquilizers, individuals may experience dizziness, lightheadedness, fatigue, difficulty breathing, and unresponsiveness.
- Cheap production. Fentanyl is relatively inexpensive to make which allows the substance to be more readily available to users.
- Unknown potency when illegally produced. Much of the fentanyl found in America is trafficked through China and Mexico. Because this illegal distribution is unregulated by any form of government, many people don’t know the potency of the drug they purchase.
Despite these dangers, many people find themselves addicted to fentanyl.
What Is Fentanyl Addiction and How Does It Happen?
When individuals become addicted to fentanyl, they have an uncontrollable desire to use the substance despite any potentially harmful physical, social, emotional, or personal consequences. Even though the desire to use fentanyl is compulsive, most addictions begin as impulsive decisions that cause changes in the brain over time.
Fentanyl, like heroin, morphine, and other opioids, works by binding to opioid receptors in parts of the brain that control pain and emotions. Fentanyl blocks pain messages sent to the body from these receptors. By doing this, fentanyl diminishes the perception of pain. This allows individuals to experience temporary relief from pain.
But that’s not all fentanyl does. The drug also interferes with the brain’s reward system and disrupts many processes and vital functions that take place in the central nervous system.
When individuals take fentanyl, the brain receives an influx of dopamine, a chemical messenger that plays an important role in pleasure, emotion, motivation, and learning. This excessive amount of dopamine can create a short-lived euphoric high, even when individuals take fentanyl medically. This high is one of the main reasons why some individuals use fentanyl recreationally. Unfortunately, this high, which is also accompanied by temporary pain relief, doesn’t last long. To maintain this sense of euphoria, many individuals continue using fentanyl, which can harm the brain.
Normally, the brain only needs a certain amount of dopamine to function properly. But the brain adapts quickly. Instead of discarding the excess dopamine, the brain adjusts to the increased levels. Because of this, the brain stops producing dopamine on its own, making fentanyl the primary source of dopamine. Because of this, many individuals taking fentanyl have difficulty finding pleasure in anything else besides the drug, which compels them to continue to use the substance. In addition, the brain is wired to want to continue seeking out substances that produce pleasure. Sadly, this increases their tolerance to fentanyl.
Tolerance is a natural process that happens when the body is regularly exposed to a medication or substance. When individuals have consumed any medication or substance for an extended period of time, their body becomes accustomed to the substance. This usually means that the current dosage isn’t as effective as it once was. Because of this, individuals need higher doses of the same substance more frequently to achieve the same effects. As tolerance to fentanyl increases, individuals need more of the drug to feel that earlier sense of euphoria and pain relief. Unfortunately, increased tolerance can make individuals dependent on fentanyl.
When individuals become dependent on fentanyl, their body ‘needs’ the substance to function and operate normally. If individuals reduce the amount of fentanyl they consume or try to quit the substance altogether, they experience withdrawal symptoms. Withdrawal symptoms can vary from person to person and can range from mild to severe. Some of the most common fentanyl withdrawal symptoms include:
- Stomach cramps
- Irritability and agitation
- Unexplained pain in the joints and/or muscle
- Muscle weakness
- Mood swings
- A persistent headache
- Diarrhea or constipation
- Elevated heart rate
- Hypertension, or high blood pressure
- Uncontrollable leg movements
- Intense anxiety that often leads to panic attacks
- Flu-like symptoms such as a runny nose, watery eyes, low-grade fever, chills, general discomfort, and aches and pains
- Night sweats
- Severe cravings
Generally, these symptoms compel individuals to seek relief from physical or emotional pain. Desperate, many of them turn to fentanyl, further increasing their risk of addiction. When individuals are dependent on fentanyl, they often:
- Increase the amount of fentanyl they consume
- Attempt to self-medicate withdrawal symptoms with more fentanyl
- Look for ways to satisfy their severe, intense cravings for the substance
At this point, using fentanyl is less about experiencing pleasure and more about avoiding pain. Individuals can be dependent on fentanyl without becoming addicted to the substance. However, without professional addiction treatment, most people dependent on fentanyl eventually find themselves addicted to the substance.
Signs of a Fentanyl Addiction
The signs and symptoms of addiction vary from person to person, but most people living with an addiction to fentanyl exhibit certain physical, behavioral, cognitive, and psychosocial symptoms.
Generally, individuals with a fentanyl addiction:
- Continue to abuse the substance despite negative consequences
- Isolate themselves from others
- Spend a lot of time obtaining, using, and recovering from fentanyl
- Have slurred speech
- Frequently miss work or school
- Have declined performance at work or school
- Neglect daily responsibilities
- Visit multiple doctors to obtain multiple fentanyl prescriptions
- Forge prescriptions to obtain more fentanyl
Physically, individuals may experience:
- Blurred vision
- Constricted pupils
- Nausea and vomiting
- Constant drowsiness
- Strong cravings for fentanyl
- Swollen hands and feet
- Increased heart rate
- Difficulty breathing
- Unconsciousness in the form of a coma
Cognitively, individuals may have:
- Difficulty paying attention
- Trouble concentrating
- Impaired memory
- Impaired judgment
- Suicidal ideation and thoughts
If you or someone you know is struggling with suicidal thoughts, please contact your healthcare provider or the National Suicide Prevention Lifeline at 800–273–8255.
Individuals might also experience psychological signs of addiction which can include:
- Euphoria followed by apathy
- A loss of interest in things they once enjoyed
Long-Term Effects of Fentanyl Addiction
Prolonged fentanyl addiction can have several negative effects on an individual’s life. These consequences can be emotional, financial, or legal. Some individuals may experience strained relationships with family members and close friends. Other people face:
- Job loss
- Academic or occupational failure
- Criminal charges
Fentanyl addiction can affect an individual’s physical health as well. Some of the long-term effects that can develop as a result of fentanyl addiction include:
- Personality changes
- A weakened immune system
- Delusions or hallucinations
- Gastrointestinal problems
- Fatigue and an increased feeling of sedation
- Oxygen deficiency in the body’s tissues
- New or worsening mental health symptoms
- Dry mouth and nose
- Impaired visual ability
Other long-term effects of fentanyl addiction can include:
- Decreased production of norepinephrine. Norepinephrine is a brain chemical responsible for providing the body energy. Low levels of norepinephrine can cause chronic migraines, low blood sugar, depression, anxiety, loss of interest in activities once enjoyed, brain fog, and lack of motivation.
- Reduced heart rate and body temperature. Bradycardia, or slow heart rate, can cause individuals to feel lightheaded, confused, or constantly tired. A reduced heart rate can also make individuals more susceptible to cardiovascular problems. Having a reduced body temperature can lead to hypothermia. Low body temperature can also slow brain activity and breathing. When left untreated, hypothermia can result in heart and respiratory failure and eventually death.
- Deterioration of white matter in the brain. When this happens, individuals may be less able to regulate their emotions and react to stress in a healthy way. They may also have trouble making rational decisions. If left untreated, an addiction to fentanyl can easily destroy an individual’s life. Luckily, professional addiction treatment, behavioral therapy, and medication-assisted treatment can help individuals overcome an addiction to fentanyl.
Treatment For Fentanyl Addiction
Like other opioid addictions, medication, behavioral therapies, counseling, and peer support groups can help treat fentanyl addiction. Most professional addiction treatment programs help individuals overcome an addiction to fentanyl by:
- Detoxing the body
- Providing medications to help ease withdrawal symptoms
- Changing harmful behavioral patterns in behavioral therapy
- Healing wounds, overcoming trauma, repairing relationships, and teaching healthy coping skills in individual, group, and family counseling
- Encouraging individuals to stay sober in peer support groups
- Helping individuals transition back into everyday life with aftercare support programs
Read more about Fentanyl abuse and how to seek help if you or a loved one might be struggling with addiction at the full guide ‘Fentanyl Addiction’